Taking Care of Your Diabetes

www.PalomarHealth.org/Diabetes

Table of Contents

What is Diabetes? 1 Blood Sugar Testing 3 Diabetes Medicines 5 Waste Collection Information 14 Hypoglycemia 15 Hyperglycemia 17 Sick Day Guidelines 19 Diabetic Ketoacidosis (DKA) 20 Healthy Meal Planning 21 Foods with Carbohydrates 22 Combination Foods 24 Reading a Nutrition Label 25 Foot Care 26 Diabetes and Emotions 27 Palomar Health Services 30 Good Questions for Your Good Health 32 Introduction

Thank you for choosing Palomar Health. We want to thank you for allowing us to care for you. Your safety, comfort and satisfaction with our services are very important to us.

In this book you will find information on:

■■ Types of diabetes ■■ What to do when you are sick ■■ Testing your blood sugar ■■ Healthy food choices ■■ Diabetes medications ■■ Exercise ■■ Hypoglycemia or low blood sugar ■■ Community education programs ■■ Hyperglycemia or high blood sugar and resources

While you are in the hospital, please ask your doctor and nurses about your: ■■ Diabetes ■■ Medications ■■ Follow-up doctor appointments ■■ Diabetes education classes and a support group Please bring this book with you to your doctor visits and/or classes that you attend.

If you happen to come back to Palomar Health, please have someone bring this book to the hospital so that we can continue to go over any information you may want or need during your stay.

We wish you good health.

Sincerely,

Palomar Health & the Diabetes Services Department

Our mission: To heal, comfort and promote health in the communities we serve.

Our vision: Palomar Health will be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services. What is Diabetes?

Diabetes is a disease in which the body does not make enough insulin and/or the cells in the body have a hard time using the insulin your body makes.

Without enough insulin, your cells cannot get the fuel it needs to use for energy.

The two most common types of diabetes:

Type 1 diabetes: When you have Type 1 diabetes, your body stops making insulin. If you have Type 1 diabetes, you must take insulin.

Type 2 diabetes: When you have Type 2 diabetes, your body is not making enough insulin nor is it using insulin the right way.

There is no cure for diabetes. Diabetes does not go away. It is important to talk with your doctor or nurse about getting information on how to take care of your diabetes.

Notes:

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1 Why should I care about my diabetes?

Over time, high levels of sugar can damage blood vessels, nerve endings and other organs in your body.

Health problems that can occur are: ■■ Heart attack ■■ Stroke ■■ Eye problems that can lead to trouble seeing or going blind ■■ Pain, tingling or numbness in your hands and feet ■■ Kidney problems ■■ Teeth and gum problems ■■ Skin disorders ■■ Sexual disorders ■■ Stomach problems Keeping your blood sugar numbers in your target range can help you stay healthy.

What is a blood sugar goal? ■■ A blood sugar goal is a range of blood glucose values that you want to maintain on a daily basis. ■■ Having a blood sugar goal helps you to manage your diabetes. ■■ We encourage you to work with your doctor or health-care provider to help you decide a blood sugar goal that fits your needs. ■■ Blood sugar goals for most people with diabetes:

Goal Target Ranges Time Target Ranges

Before Meals 80 –130

After Meals (1–2 hours) Less than 180

2 Blood Sugar Testing

How do I know what my blood sugar is? The following are two ways to measure your blood sugar:

1. Testing your blood sugar with a glucose meter. 2. A1C (pronounced A-one-C) blood test. Why should I check my blood sugar? Checking your blood sugar helps you to see how food, physical activity, stress and medicine affect your blood sugar. ■■ Keep a logbook of your blood sugar numbers and your A1C test. ■■ Bring your logbook or glucose meter to each visit with your doctor. How often do I check my blood sugar? Ask your doctor when and how often you need to check your blood sugar.

What equipment do I need to test my blood sugar? ■■ Blood glucose meter ■■ Blood glucose test strips. Blood glucose test strips are specific to the meter you will be using and are placed into the meter. ■■ Lancets. A lancet is a needle device used to get a small amount of blood from your finger. ■■ A sharps disposal container to throw away your needles and lancets.

Your blood glucose meter will come with instructions on how to set up your meter. Please call the toll-free number on your meter if you are having problems with the meter.

3 What is the A1C test? ■■ The A1C test is a blood test done in a lab that measures your average blood sugar levels over the past 2 to 3 months. Why should I have an A1C test? ■■ The A1C test will tell you if your blood sugar levels have been close to normal, too high or too low. ■■ The higher the amount of sugar in your blood, the higher your A1C result will be. How often do I need an A1C test? ■■ A1C tests are usually done every 3 to 6 months. ■■ Please ask your doctor each office visit if you have not had one in the past few months. What should my A1C goal be? ■■ Discuss with your doctor what A1C goal is right for you. ■■ An A1C goal of less than 7 percent is usually recommended for people living with diabetes. If your A1C is not at your goal, ask your doctor about helping you change your treatment plan.

13 326 12 298 11 269 10 240

A1C = Your average blood sugar 9 212 8 183 7 154 Over the past My A1C is 6 126 2-3 months. Estimated 5 100 What’s your Number? ______Average A1C % 4 65 Sugar

4 Diabetes Medicines: Insulin

Insulin ■■ Insulin lowers the blood sugar by moving sugar from the blood into the cells of the body. ■■ Insulin is taken only by injection. ■■ People living with Type 1 diabetes do not make insulin. Insulin is always needed. ■■ Some people living with Type 2 diabetes may need insulin. Ask your doctor: ■■ When to take your medicines ■■ How much to take ■■ How often to take them ■■ What side effects they may cause 5 Types of insulin There are many different types of insulin.

Rapid-acting insulin ■■ Insulin glulisine (Apidra) ■■ Insulin lispro (Humalog) ■■ Insulin aspart (NovoLog) After injecting this type of insulin into the body, it will: ■■ Begin to have an effect on blood sugar in about 15 minutes. ■■ Peak, or have its strongest effect on blood sugar in about 1 hour. ■■ Affect blood sugar for about 2 to 4 hours. Regular or short-acting insulin ■■ Humulin R ■■ Novolin R After injecting this type of insulin into the body, it will: ■■ Begin to have an effect on blood sugar within 30 minutes. ■■ Peak, or have its strongest effect on blood sugar in 2 to 3 hours. ■■ Affect blood sugar for about 3 to 6 hours. Rapid and short-acting insulin should look clear to you and have no particles in the bottle.

Rapid acting insulin that is cloudy, has a different color or has particles in the bottle should not be used.

6 Intermediate-acting insulin ■■ NPH (Humulin N, Novolin N) After injecting this type of insulin in the body, it will: ■■ Begin to have an effect on blood sugar in 2 to 4 hours. ■■ Peak, or have its strongest effect on blood sugar, in about 4 to 12 hours. ■■ Affect blood sugar for about 12 to 18 hours. Intermediate-acting insulin should look cloudy to you and have no particles in the bottle.

Long-acting insulin ■■ Insulin glargine (Lantus) ■■ Insulin detemir (Levemir)

After injecting this type of insulin into the body, it will: ■■ Begin to have an effect on blood sugar levels in about 1 to 2 hours. ■■ Have no peak time. ■■ Affect blood sugar levels evenly over about 24 hours. Long-acting insulin should look clear to you and have no particles in the bottle.

7 How do I store my insulin? The way insulin is stored can affect how well the insulin will work on your blood sugar. ■■ Insulin can be stored in the refrigerator. ■■ Allow insulin that has been stored in the refrigerator to warm to room temperature for at least 15 minutes before using it. ■■ Do not use insulin that has been stored in a freezer or insulin that was frozen. ■■ Insulin should not be stored in the sun, on a window sill or near a heater. Insulin that is at warmer temperatures will not work as well. ■■ Always look for cracks in the insulin bottle. ■■ Insulin bottles are labeled with an expiration date. ■■ Unopened bottles of insulin are good for up to the date written on the bottle. ■■ Once the cap is removed from an insulin bottle, it is good to use for up to 28 days. Insulin that has particles, or that has expired is not recommended for use. Please contact your doctor or pharmacy if you have any concerns.

How do I take my insulin safely? ■■ Check your blood sugar before you take insulin. ■■ Use caution when drinking alcohol. ■■ Do not skip meals. ■■ Try to eat about the same time every day. ■■ Always have a snack, hard candy or glucose tablets with you.

8 Where can I inject my insulin? Insulin is injected into the layer of fat, just below the skin.

Four areas where you can inject insulin: 1. Abdomen (belly). The abdomen is the preferred site to use. 2. Back of the upper arm 3. Front and upper, outer side of the thighs 4. Upper part of the buttocks Injection tips Always rotate injection sites. Try to inject insulin one inch away from the previous injection site.

Do not inject insulin into: ■■ Scar tissue, such as from surgery ■■ Red, swollen, bleeding or infected areas ■■ Stretch marks ■■ Tattoos ■■ Piercings ■■ A bruise ■■ A mole NEVER give the shot in your belly button. ■■ Stay at least two inches away from the belly button. ALWAYS feel the area first before injecting and do not inject insulin into areas that have lumps, bumps or hard tissue.

9 Insulin syringes ■■ Insulin is measured in units. ■■ Insulin syringes are for one-time use only. Always look to see that you have: ■■ The correct type of insulin ■■ The correct dose ■■ Are giving it at the right time How to prepare insulin from a bottle? * Always test your sugar before giving insulin.

Step 1: Get the supplies you’ll need: ■■ Insulin bottle ■■ Insulin syringe ■■ Alcohol swabs ■■ Container for the used syringe Step 2: Wash your hands.

Step 3: Check the insulin bottle to make sure it is the correct insulin and hasn’t expired.

Step 4: Remove the lid from the insulin bottle.

Step 5: Wipe the rubber top of the bottle with an alcohol swab for 10 seconds and let it dry. (For a new, unused bottle, remove the plastic top first.)

Reference: This information was provided by KidsHealth®, one of the largest resources online for medically reviewed health information written for parents, kids and teens. For more articles like this, visit KidsHealth.org or TeensHealth.org. © 1995 –2014. The Nemours Foundation/KidsHealth®. All rights reserved.

10 How do I draw up insulin from a bottle? Step 1: Remove the cap from the syringe.

Step 2: Step 3: Step 4: Step 5: Pull air into the Gently, push the Push the plunger so Turn the insulin bottle syringe by pulling needle through the that all of the air goes and syringe upside back on the plunger rubber top of the from the syringe into down. until its black tip is bottle. the bottle. To pull insulin into the even with the line syringe, slowly pull showing the dose back on the plunger you’ll need. until the top of its black tip is even with the line showing your dose.

Gently, take the needle and syringe out of the bottle.

■■ Remove any air bubbles in the syringe by gently tapping the syringe with your finger or a pen. This will send the air bubble(s) to the top of the syringe and you can push them back into the insulin bottle. ■■ Make sure to support the syringe when tapping so it does not get dislodged from the bottle. ■■ After removing the air bubbles, look to see that you still have the correct amount of insulin in the syringe. If you do not, you may need to pull out more insulin.

11 How do I inject insulin?

Step 1: Step 3: Clean skin of the Let go of the pinched injection site with skin, and slowly push alcohol or antibacterial the plunger to inject all soap and water and of the insulin. allow to dry. Step 4: Step 2: Leave the needle in Gently pinch the skin. place for 5 seconds Hold the syringe at a before pulling out the 90-degree angle needle. (straight in) to the skin, and push the needle all Step 5: the way in. Gently take the needle out of the skin tissue.

■■ Dispose of the used syringe as directed by your local waste management company or health department. (See page 14)

12 Insulin Pens

Insulin syringes ■■ When picking up your insulin pens ask your pharmacy about how to store your pens. ■■ Read the instructions that come with your insulin pens before using the first time. ■■ Remember to dial 2 units of insulin to test your needle. Be sure you see drips of insulin coming out of the needle before dialing your dose. ■■ Only use insulin pen needles once. ■■ Empty insulin pens can be thrown away in regular trash. ■■ Insulin pen needles can be thrown away in a hard, plastic container (see page 14).

13 Waste Collection Info For a Waste Local sharps waste collection facilities: Collection Facility Escondido HHW Collection Facility near you, contact the 1044 West Washington Avenue San Diego Household Escondido, CA 92025 Hazardous Waste 760.745.3203 Hotline at: 877.713.2784 Poway Household Hazardous Waste Collection Facility 12325 Crosthwaite Circle Poway, CA 92064 800.714.1195

Vista Household Hazardous Waste Collection Facility 1145 East Taylor Street Vista, CA 92084 800.714.1195

Keep used Sharps are: needles out ■■ Needles of the trash! ■■ Syringes ■■ Lancets Or any other device used for injection of medication or blood tests on people or pets.

Used sharps can pose a serious threat by: ■■ Injuring waste workers, health-care providers, children and animals. Store sharps in ■■ Spreading diseases such as HIV/AIDS, approved sharps Hepatitis, Tetanus and Syphilis. containers It is illegal to: Or in a rigid, puncture ■ resistant, tightly sealed ■ Put sharps in trash or recycling containers. container, labeled ■■ Flush sharps down the toilet. "needles."

14 Hypoglycemia

Too little glucose (sugar) in your blood is called hypoglycemia or low blood sugar. Hypoglycemia is a blood sugar level of less than 70. Diabetes itself doesn’t cause low blood sugar. But some of the treatments for diabetes, such as pills or insulin, may increase your risk for it. Low blood sugar may cause you to lose consciousness or have a seizure. So always treat low blood sugar right away, but don't overeat.

Special note: Always carry a source of fast-acting sugar and a snack in case of hypoglycemia.

What you may notice If you have low blood sugar, you may have 1 or more of these symptoms: ■■ Shakiness or dizziness ■■ Cold, clammy skin or sweating ■■ Feelings of hunger ■■ Headache ■■ Nervousness ■■ A hard, fast heartbeat ■■ Weakness ■■ Confusion or irritability ■■ Blurred vision What you should do ■■ First, check your blood sugar. If it is too low (out of your target range), eat or drink 15 to 20 grams of fast-acting sugar. This may be 3 to 4 glucose tablets, 4 oz (half a cup) fruit juice or regular (non-diet) soda, 8 oz (one cup ) fat-free milk or 1 tablespoon of honey. Don’t take more than this, or your blood sugar may go too high. ■■ Wait 15 minutes. Then recheck your blood sugar if you can. ■■ If your blood sugar is still too low, repeat the steps above and check your blood sugar again. If your blood sugar still has not returned to your target range, contact your health- care provider or seek emergency care. ■■ Once your blood sugar returns to target range, eat a snack or meal.

© 2000 –2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your health-care professional's instructions.

15 Preventing low blood sugar ■■ If your condition needs a rigid treatment plan, eat your meals and snacks at the same times each day. Don’t skip meals! ■■ If your treatment plan allows you to change when you eat and what you eat, learn how to change the time and dose of your rapid-acting insulin to match this. ■■ Ask your health-care provider if it is safe for you to drink alcohol. Never drink on an empty stomach. ■■ Take your medication at the prescribed times. ■■ Always carry a source of fast-acting sugar and a snack when you’re away from home. Other things to do ■■ Carry a medical ID card or wear a medical alert bracelet or necklace. It should say that you have diabetes. It should also say what to do if you pass out or have a seizure. ■■ Make sure your family, friends and coworkers know the signs of low blood sugar. Tell them what to do if your blood sugar falls very low and you can’t treat yourself. ■■ Keep a glucagon emergency kit handy. Be sure your family, friends and coworkers know how and when to use it. Check it regularly and replace the glucagon before it expires. ■■ Talk to your health-care team about other things you can do to prevent low blood sugar.

16 Hyperglycemia

Too much glucose (sugar) in your blood is called hyperglycemia or high blood sugar. High blood sugar can lead to a dangerous condition called ketoacidosis. In severe cases, it can lead to coma.

Possible causes of hyperglycemia ■■ Inadequate treatment plan for diabetes ■■ Being sick ■■ Being under stress ■■ Taking certain medications, such as steroids ■■ Eating too much food, especially carbohydrates ■■ Being less active than usual ■■ Not taking enough diabetes medication Symptoms of hyperglycemia Hyperglycemia may not cause symptoms. If you do have symptoms, they may include: ■■ Thirst ■■ Frequent need to urinate ■■ Feeling tired ■■ Nausea ■■ Itchy, dry skin ■■ Blurry vision ■■ Fast breathing ■■ Weakness ■■ Dizziness ■■ Wounds or skin infections that don’t heal ■■ Unexplained weight loss if hyperglycemia lasts for more than a few days

17 What you should do ■■ Check your blood sugar. ■■ Drink plenty of sugar-free, caffeine-free liquids such as water. Don’t drink fruit juice. ■■ Check your blood sugar again every 4 hours. If you take insulin or diabetes medications, follow your sick-day plan for taking medication. Call your health-care provider if you are not able to eat. ■■ Check your blood or urine for ketones as directed. ■■ Call your health-care provider if your blood sugar and ketones do not return to your target range. Preventing high blood sugar To help keep your blood sugar from getting too high: ■■ Control stress. ■■ When you're ill, follow your sick-day plan. ■■ Follow your meal plan. Eat only the amount of food on your meal plan ■■ Follow your exercise plan. ■■ Take your insulin or diabetes medications as directed by you health-care team. Also test your blood sugar as directed. If the plan is not working for you, discuss it with your doctor. Other things to do ■■ Carry a medical ID card or wear a medical alert bracelet. It should say that you have diabetes. It should also say what to do in case you pass out or go into a coma. ■■ Make sure family, friends and coworkers know the signs of high blood sugar. Tell them what to do if your blood sugar gets very high and you can’t help yourself. ■■ Talk to your health-care team about other things you can do to prevent high blood sugar.

18 Sick Day Guidelines

What do I do when I am sick? The stress of being ill causes your blood sugar to go up. During an illness, even if you are not eating as usual, your blood sugar may rise. 1. Keep taking your usual dose of diabetes medicines. 2. Check your blood sugar every 2 to 4 hours or as directed by your doctor. 3. Drink at least 8 ounces per hour of the any of the following: ■■ Sugar-free liquids ■■ Caffeine-free liquids, like broth ■■ Decaffeinated tea or coffee ■■ Water ■■ Clear diet soda 4. If you cannot eat solid food: ■■ Drink fruit juice or regular soda ■■ Eat Jell-O or popsicles 5. Check your blood sugar more often to be sure it does not increase. 6. Rest.

Call your doctor or nurse if you have any one of the following:

■■ Vomiting more than once in four to six hours ■■ Unable to eat or drink ■■ Positive ketones in your urine ■■ Diarrhea that does not go away ■■ Blood sugar values over 240 for 2 tests in a row

19 Diabetic Ketoacidosis (DKA)

DKA is a life threatening illness. It occurs when the cells in your body cannot get enough sugar (glucose) for energy. Your body then starts breaking down fat and making acids (ketones).

You may have the following symptoms: ■■ Increased urination ■■ Thirsty ■■ Flushed skin ■■ Blurry vision ■■ Sick to your stomach and throwing up ■■ Breathing fast and your breath smells like fruit ■■ Fast heart rate ■■ High blood sugar ■■ Stomach pain and muscles aching Call your doctor if you are experiencing any of these symptoms. Causes ■■ Not enough insulin (your body needs insulin to help sugar get into your cells for energy) ■■ Something causing stress: Infection, Emotional Stress ■■ New Diabetes

20 Healthy Meal Planning

An important part of caring for your diabetes is having a healthy meal plan in which you can follow and enjoy.

What is a carbohydrate (CHO)? ■■ Carbohydrates are sugars. Your body uses sugar for energy. ■■ Foods that contain carbohydrates raise your blood sugar. The following foods have carbohydrates: ■■ Breads, tortillas, bagels, pasta, rice ■■ Cereals, crackers ■■ Some vegetables (corn, peas, beans, potatoes) ■■ Milk, yogurt, ice cream ■■ Fruit, fruit juices ■■ Cakes, cookies Your doctor would like you to eat ______servings of carbohydrates per meal or total of ______carbohydrate servings per day.

One serving is equal to 15 grams of carbohydrates. ■■ 15 grams of carbohydrates equals 1 serving of carbohydrates. ■■ 30 grams of carbohydrates equals 2 servings of carbohydrates. ■■ 45 grams of carbohydrates equals 3 services of carbohydrates. ■■ 60 grams of carbohydrates equals 4 servings of carbohydrates. By keeping track of how many grams of carbohydrates you eat and setting a limit, you can help keep your blood sugar levels in your target range.

21 Foods with Carbohydrates

Each food portion listed below has approximately 15 grams of carbohydrates.

Milk Fruit juices Fat-free and low-fat Apple, pineapple, orange 1/2 cup Fat-free (skim) milk 1 cup Fruit Nectars, grape, prune 1/3 cup 1% milk 1 cup cranberry juice cocktail 2% milk 1 cup Bread Low lactose milk (Lactaid) 1 cup Tortilla, corn or flour, 6 inch 1 Evaporated fat-free milk 1/2 cup English muffin 1/2 Soy 1 cup White, wheat, rye 1 slice Yogurt Hamburger or hot dog bun 1/2 Plain fat-free yogurt 2/3 cup Small, plain roll 1 Yogurt, frozen, fat-free 1/3 cup Taco shells (5 inch size) 2 Ice cream, light, 1/2 cup Cereals (no sugar added) Oats (cooked) 1/2 cup Fruits Granola, low-fat 1/4 cup Small (4 ounce) apple, orange 1 Unsweetened cereal 3/4 cup Fresh apricots 4 whole Applesauce, unsweetened 1/2 cup Banana 1/2 Fresh Cherries 12 Grapes, small 17 Blackberries, Blueberries 3/4 cup Dried Prunes 3 Watermelon (cubed) 1 1/4 cups Raisins 2 Tbsp. Strawberries, whole 1 1/4 cups

Reference: Academy of Nutrition and Dietetics

22 Each food portion listed below has approximately 15 grams of carbohydrates.

Grains Crackers and snacks Pasta (cooked) 1/3 cup Animal crackers 8 Rice, white or brown (cooked) 1/3 cup Graham crackers, 3 squares Khus khus (cooked) 1/3 cup 2 1/2 inch square Quinoa (cooked) 1/3 cup Gingersnaps 3 Pretzels 3/4 oz. Starchy vegetables Popcorn, low-fat, popped 3 cups Corn 1/2 cup Rice cakes, 4 inch across 2 Mixed vegetables with 1/2 cup corn, peas or pasta Sweets Peas, green 1/2 cup Cookies, small 2 Potato, baked 1/4 large Sherbet or sorbet 1/2 cup with skin (3 oz.) Ice cream 1/2 cup Potato, mashed or diced 1/2 cup Frozen yogurt 1/2 cup Squash, winter 1 cup (acorn, butternut or pumpkin) Yam, sweet potato (plain) 1/2 cup Beans Baked beans 1/3 cup Beans, cooked 1/2 cup (black, garbanzo, kidney, lima, navy, white) Peas, cooked 1/2 cup (black-eyed, split) Lentils, cooked 1/2 cup (brown, green, yellow) Refried beans, canned 1/2 cup

Reference: Academy of Nutrition and Dietetics

23 Combination Foods

Soups Serving Size Carbohydrates Bean, tomato, cream, broth-based 1 cup (8 oz.) 15 grams Split pea soup 1/2 cup (4 oz.) 15 grams

Entrees Lasagna, bean chili 1 cup (8 oz.) 30 grams Mac and cheese 1 cup (8 oz.) 30 grams Pizza, meat topping, thin crust 1/4 of 10 inches 30 grams Pizza cheese, thin crust 1/4 of 10 inches 30 grams

Frozen dinners Turkey with gravy, mashed potatoes 11 oz. 30 grams Salisbury steak with gravy, mashed potatoes 11 oz. 30 grams

Fast foods Hamburger 1 30 grams French fries 20–25 30 grams Hot dog with bun 1 30 grams Taco hard shell 1 (6 oz.) 30 grams Taco soft shell 1 (3 oz.) 15 grams Beef burrito 1 30 grams

Reference: Academy of Nutrition and Dietetics

24 Reading a Nutrition Label

How to count carbohydrates using a food label:

Step 1: Look at the serving size. A serving size may be a cup, a bar, a packet. The serving size in this example is 2/3 of a cup.

Step 2: Look at the total carbohydrates. Carbohydrates are measured in grams. Example from this label: The total carbohydrates in 2/3 of a cup is 37 grams.

Healthy eating tips: ■■ Talk to your doctor about setting up a time to meet with a dietician to help you with menu planning. ■■ Try to eat regularly through-out the day. ■■ Keep the amount of carbohydrates you eat the same each day. ■■ Choose: ■■ lean meats, chicken and fish ■■ low-fat foods and avoid fried foods ■■ fresh fruits instead of fruit juices ■■ food with low or no salt added ■■ When eating out, ask to see the nutritional values in your meal.

25 Foot Care

Caring for your feet is important and good for your health. Here are some tips to help you care for your feet.

Look at your feet every day. ■■ Look for sores, cuts, bruises, cracks or burns that are not healing. Keep your feet clean and dry. ■■ Wash your feet daily with warm, not hot, water. ■■ Apply lotion to the bottom of your feet but not between the toes. Lotion between the toes can cause an infection. Wear socks and comfortable shoes on your feet at all times. ■■ Wearing socks and good shoes will protect you from stepping on something. ■■ Do not walk barefoot inside or outside your home. ■■ Always feel inside your shoes before putting them on. Make sure the inside of your shoes are smooth and nothing is in them. Take off your socks and shoes at your doctor’s visits and ask the doctor to look at your feet.

Call your doctor for any problems with your feet.

26 Diabetes and Emotions

Living well with diabetes takes time and effort. It is only natural at times you may feel like it is too difficult for you to manage.

Are you feeling any of the following emotions? ■■ Sad ■■ Frustrated ■■ Angry ■■ Scared ■■ Unmotivated ■■ Helpless What can you do? ■■ Talk with your doctor or nurse. Share what you are feeling. ■■ Tell your family or friends that you are having a difficult time. Share how they can help you. ■■ Learn about diabetes. Attend a diabetes class or a support group. Visit the following website www.behavioraldiabetes.org for more information.

27 To Learn More

American Diabetes Association www.diabetes.org

American Association of Diabetes Educators www.diabeteseducator.org

Taking Control of Your Diabetes (TCOYD) www.tcoyd.org

Community Diabetes Programs Arch Health Partners Indian Health Services 858.675.3100 619.234.2158

Kaiser Health Education Neighborhood Health Care 619.641.4194 760.520.8100

Graybill Medical Group North County Health Services 1.866.228.2236 760.736.6767

Vista Community Clinic 760.631.5220

28 Tell Us About Your Experience

Your comments are important to us Following your visit with us, you may receive a survey asking about your experience with Palomar Health. We value your feedback and look forward to receiving your response.

If you have an experience you would like to share with us about your visit to Palomar Health, please contact us directly by calling 888.604.0678 or 760.740.6345 or by emailing [email protected] .

It is our privilege to serve you.

29 Palomar Health Services

Palomar Health Expresscare Clinics Our walk-in health clinics are located within select Albertson’s/Sav-on pharmacy stores. Certified family nurse practitioners work in collaboration with board-certified physicians and provide care for common medical conditions including: strep throat, allergies, ear infections, skin conditions, cold and flu and minor injuries as well as vaccinations, physical exams, select health screenings, smoking cessation and lab draw.

Store locations: Escondido, Rancho Peñasquitos, 888.738.2452 San Marcos and Temecula

Palomar Health Wound Care Centers Provide care to patients with chronic, non-healing wounds and conditions receptive to Hyperbaric Oxygen Therapy (HBOT).

Wound Care locations: San Marcos 760.510.7300 Poway 858.613.6255

Palomar Health Sleep Lab 760.739.3685 Our sleep lab specializes in diagnosing and treating breathing-related sleep disorders.

Palomar Center for Behavioral Health 800.336.2000 Our Center meets the diverse and complex psychiatric and mental health needs of adults (18 years and older) and older adults with a comprehensive range of services. These services include crisis intervention, inpatient care, intensive outpatient services and detoxification.

Palomar Health Home Caregivers 760.796.6860 We offer comprehensive in-home care, 24 hours-a-day, to North County residents who need assistance with their activities of daily living. Available services include: personal care, companionship, overnights, light housekeeping, home safety measures, shopping, errands, transportation, new-mom assistance, respite relief for family and medication reminders.

Philips Lifeline Medical Alert 888.595.4693 Protect your loved ones and experience the comfort and peace of mind that comes from living with Philips Lifeline. If you experience a fall or other emergency, every second counts. At the push of a button, you receive help and assistance from a trained Lifeline Response Associate 24 hours-a-day.

30 Notes:

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31 Good Questions for Your Good Health

Good Questions Ask TM for Your Me3 Good Health

Every time you talk with a doctor, nurse, or pharmacist, use the Ask Me 3 questions to better understand your health.

u What is my main problem? v What do I need to do? w Why is it important for me to do this?

When to Ask Questions What If I Ask and Still Who Needs to Ask 3? Don’t Understand? You can ask questions when: • Let your doctor, nurse, or Everyone wants help with health • You see your doctor, nurse, or pharmacist know if you still don’t information. You are not alone pharmacist. understand what you need to do. if you ﬁnd things confusing at • You prepare for a medical test or times. Asking questions helps you procedure. Will you please explain that to me understand how to stay well or to • You get your medicine. one more time?” get better.

Ask Me 3 questions are designed to help you take better care of your health. To learn more, visit www.

32 Your Doctor, Nurse, and Pharmacist Want to Answer 3 Bring your medicines with you the next time Are you nervous to ask your health provider questions? you visit your doctor or pharmacist. Or, write Don’t be. You may be surprised to learn that your medical the names of the medicines you take on the lines team wants you to let them know that you need help. below. Like all of us, doctors have busy schedules. Yet your doctor wants you to know: • All you can about your condition. • Why this is important for your health. • Steps to take to keep your condition under control. Asking these questions can help me: ~ Take care of my health ~ Prepare for medical tests Like many people, you may see more than ~ Take my medicines the right way one doctor. It is important that your doctors know all the medicines you are • I don’t need to feel rushed or embarrassed if I don’t taking so that you can stay healthy. understand something. I can ask my doctor again. • When I Ask 3, I am prepared. I know what to do for my health.

Write Your Doctor’s Answers to the 3 Questions Here: u What is my main problem?

v What do I need to do?

w Why is it important for me to do this?

Ask Me 3TM is an educational program provided by the Partnership for Clear Health Communication at the National Patient Safety FoundationTM – a Partnership for coalition of national organizations that are working Clear Health Communication together to promote awareness and solutions around at the National Patient Safety FoundationTM the issue of low health literacy and its e ect on safe care and health outcomes. www.npsf.org

APat2-E 10-07

33 Notes:

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34 Notes:

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